Your postmenopausal 60-year-old female patient complains of ...

[clippers!]

Your postmenopausal 60-year-old female patient complains of vaginal irritation and pruritus of the external genitalia. She self-medicated with an over-the-counter anti-candida agent. However, the vaginal symptoms persist.
 
  The clinician should recognize that:
  A. Over-the-counter medications do not treat all species of candida
  B. Postmenopausal women are susceptible to trichomonas infection
  C. Decreased estrogen makes vaginal mucosa susceptible to bacterial vaginosis
  D. Irritation due to atrophic vaginal mucosa can mimic symptoms of candida

Question 2

A 20-year-old female complains of thin vaginal discharge and pruritus. On pelvic examination, there are strawberry spots on the vaginal walls. With this infection, it is important to:
 
  A. Treat the patient's partner
  B. Perform STD and HIV testing
  C. Look for characteristic clue cells
  D. A and B

[Christopher]

Answer to Question 1

ANS: D
Although atrophic vaginitis is not an infection and does not cause a discharge, its signs and symptoms can mimic the C. albicans yeast vaginitis. It occurs in postmenopausal women as a result of a lack of estrogen.

Answer to Question 2

ANS: D
The presenting complaints with trichomoniasis are discharge and itching. It can be differentiated from yeast by the discharge, which is thin and frothy rather than the thick, curdlike discharge of yeast. It can also be differentiated from G. vaginalis by the presence of vulvar itching and inflammation with trichomoniasis but no complaint of odor, as there is with G. vaginalis. Inflammation with petechiae of the vaginal walls, known as strawberry spots, is diagnostic of T. vaginalis. Male partners are usually asymptomatic but harbor the organism, and they must be treated along with the patient; intercourse should be avoided or condoms used until treatment is completed.

[clippers!]

Excellent

[nanny]

TYSM